A small state is fighting for the human right to health care -- and winning.

On April 26, Vermont's Senate passed, by a majority of 21 to 9, a universal health care bill that would ultimately provide publicly financed health care to all residents. Since the House already approved a version of this bill, which originated in Governor Shumlin's office back in February, it is almost certain that Vermont will become the first state in the country to start the process of creating a publicly financed, single-payer health care system.

Single-payer health care became politically feasible in Vermont around the same time it was sidelined and blocked in the federal health reform effort. Many attribute this to the creative and unwaveringHealthcare Is a Human Right campaign, a diverse grassroots movement built by the Vermont Workers' Center. By engaging many thousands of ordinary Vermonters in claiming their right to health care, the campaign raised the voices of the people against corporate interests profiting from the market-based health insurance system.

Yet the struggle is far from over. The legislative negotiations have shown just how much people-power it will take to prevail over the ongoing bullying from big business and insurance industry lobbyists set on cutting deals. Led by Vermont's eerily powerful largest corporate employer, IBM, and incentivized by the deep-pocketed insurance industry, lobbyists mounted a series of attacks to stall and derail universal health care reform. Human rights supporters' protests at the Vermont Statehouse managed to fend off many industry demands, yet the bill did get watered down in the process.

There is still time for improvements: as the Senate and House passed different versions of the bill, advocates have a brief opportunity for strengthening its provisions when the two chambers meet to reconcile the differences. Throughout the legislative process, supporters of the Healthcare Is a Human Right campaign have asked legislators -- often successfully -- to improve the bill's compatibility with key human rights principles, such as universality, equity, and accountability. The campaign is now preparing its final push to ensure that the bill is clear about providing health care as a public good for all, not as a commodity sold by private insurance companies.

The involvement of insurance companies and corporate employers in the new health system has, unsurprisingly, been the main point of contention. The bill maps a lengthy transition process that includes setting up an insurance exchange to comply with the federal health reform law, although Vermont may well get the Obama administration to waive this and other requirements. Yet Governor Shumlin opted for using the exchange as a stepping stone toward a single-payer system to avoid losing out on any federal funding. Because exchanges are nothing more than regulated marketplaces, the leap from an exchange to a publicly-financed health system poses a significant challenge.

Predictably, much industry lobbying has focused on weakening the exchange by fragmenting and shrinking its risk pool. The bill's initial drafters expected the exchange to achieve a process of consolidation and simplification that would trigger a withdrawal of insurance companies from health care financing. This would make it easier for public financing to kick in across the board as soon as the universal health care program -- Green Mountain Care -- was ready to supplant the exchange and provide comprehensive benefits to everyone. Yet the bill remains ambiguous about the role of private insurance companies in the new system.

Lack of specificity has been a feature of the bill from the start, reflecting the governor's strategy to deflect attacks by deferring contentious questions to future decision-making processes. This offered an opening for opponents to introduce various opt-out provisions as well as conditions for implementation. At this point, everyone realizes that this bill provides a roadmap for universal health care -- nothing more, nothing less. Many important fights still lie ahead, once the well-earned celebrations of the bill's passage subside.

Several crucial decisions will take place over the next few years, including one on the financing mechanism of the new system. The Healthcare Is a Human Right campaign succeeded in inserting in the bill a requirement for equitable financing, which would suggest individual and corporate income taxes (including on unearned income), yet no one expects this will happen without a fierce struggle. The campaign is ready to mobilize Vermonters for this and other fights, guided by human rights principles. Since a number of these principles were incorporated into the bill, Vermonters can hold the state accountable as it navigates the road to universal health care.

As the Statehouse molds Vermont's universal health care bill into its final shape, supporters of the Healthcare Is a Human Right campaign are counting on legislators to listen to the voice of the people, not that of corporations. For the third year in a row, Vermonters from across the state will assemble at the Statehouse in Montpelier on May Day to demand their human right to health care. Judging by the impact of past rallies, legislators would be well-advised to pay attention.